title: Functional electrical stimulation of peripheral muscles improves endothelial function and clinical and emotional status in heart failure patients with preserved left ventricular ejection fraction.
abstract: BACKGROUND
  Functional electrical stimulation (FES) improves exercise capacity, quality of life, emotional stress, and endothelial function in chronic heart failure with impaired systolic function. We sought to investigate the effects of FES on the above parameters in patients with preserved ejection fraction (HFpEF).
  
  
  METHODS
  Thirty HFpEF patients, 18 female and 12 male, aged 69 ± 8 years, in New York Heart Association class II or III and with mean ejection fraction 63% ± 6%, were randomly (1:1) assigned to a 6-week FES program or placebo. Assessment was performed at baseline and after completion of training protocol and included 6-minute walked distance, quality of life (Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire), depressive symptoms (Beck Depression Inventory and Zung self-rated depression scores), B-type natriuretic peptide, endothelial function (flow-mediated dilatation), and left ventricular diastolic function.
  
  
  RESULTS
  A significant improvement in 6-minute walked distance (F = 21.61, P = .001), Kansas City Cardiomyopathy Questionnaire summary (F = 8.68, P = .006), Minnesota Living with Heart Failure Questionnaire (F = 6.43, P = .017), Beck Depression Inventory (F = 6.66, P = .015), Zung (F = 6.25, P = .019), and flow-mediated dilatation diameter (F = 11.98, P = .002) was observed in the FES group compared with placebo group; B-type natriuretic peptide also declined but not significantly (F = 0.249, P = .622), and there was a tendency toward lower mitral E/e' wave ratio (F = 3.066, P = .091).
  
  
  CONCLUSIONS
  As in heart failure and reduced left ventricular ejection fraction, FES also improves exercise capacity, quality of life, emotional status, and endothelial function in HFpEF. Given the lack of effective evidence-based therapies in these patients, FES warrants further investigation.
authors.affiliation: Department of Cardiology, Georgios Gennimatas Hospital, University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.forename: Metaxia
authors.initials: M
authors.lastname: Driva
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Mantzaraki
authors.forename: Christos
authors.initials: C
authors.lastname: Varounis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Vlassios
authors.initials: V
authors.lastname: Pirgakis
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D004644:Emotions / Q000502:physiology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011788:Quality of Life; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*